2222 - Deep-Inspiration Breath Hold Radiation Treatment for Breast Cancer without Permanent Tattoos

M. Barker¹, M. Campbell¹, L. Turner¹, A. N. M. Syed², R. Wei², and P. Kabolizadeh²; ¹MemorialCare Medical Center, Long Beach, CA, ²Memorial Radiation Oncology Medical Group, Long Beach, CA

Purpose/Objective(s): Patients undergoing breast radiation therapy utilizing deep inspiration breath hold (DIBH) technique historically received tattoos to assist with daily setup alignment and verification. With the advent of surface imaging, tattoos may no longer be necessary to ensure setup accuracy. The purpose of this retrospective study is to compare setup times, overall treatment times, setup accuracy, and imaging frequency of conventional tattoo-based setups to those without reference to tattoos. Materials/

Methods: 123 DIBH breast patients who used surface guidance technology to verify the DIBH threshold were subsequently analyzed, extracting data on the total time to set up the patient per fraction, the total time to treat the patient per fraction, the deviation of the treatment couch position from the planned position, the number of images acquired, as well as patient demographics including age at first treatment day, body-mass index (BMI) at first treatment day, self-reported ethnicity, and primary language.
Results: Among patients in the tattooed group, the average treatment time per fraction was 15:29 minutes versus 12:59 minutes in the tattooless group with the main contribution being a reduction in setup time (p<0.01, 1:30 minutes p<0.01 respectively). The most significant reduction in treatment times was observed in more complicated plan types; for dual-plan techniques involving regional nodes, the average treatment time was 17:43 minutes for the tattooed cohort versus 13:30 minutes for the tattooless cohort (p<0.01). Overall 3D displacement reduced from 1.72 cm for the tattoo cohort to 1.02 cm for the tattooless cohort (p<0.01). Tattooless dual-isocenter DIBH breast plans were observed to show an overall 0.56cm 3D displacement (p<0.01). There is no correlation between patient demographics on treatment time, setup time, or 3D displacement between the cohorts.
Conclusion: Tattoos are not required for accurate and expeditious DIBH breast setups when using SGRT technology.